Nephrogenic remnants: occasional ultrasound diagnosis and follow-up.

Nephrogenic remnants (NRs) are nodular collections of undifferentiated renal blastema cells in the postnatal kidney that are recognized as putative precursor lesions of Wilms tumor (WT). NRs may remain stationary, undergo regression, or proliferate. In the last case, there is a high risk for the development of a WT. During infancy, they are most frequently of microscopic size, to be found only at autopsy in approximately 1% of infant kidneys. Approximately 1 out of 100 microscopic lesions persist and grow developing lesions large enough to be seen by ultrasound in the first months of life. We report on a case of NRs in a six year old child, as incidental finding during abdominal ultrasound performed for other purposes. In consideration of the potential evolution in WT, after a period of close surveillance of 14 months, the lesion was resected. Histological examination revealed the presence of NRs, no neoplastic lesions were found. Currently the patient is 16 years old, in good health, and there have been no signs of recurrence.

[Ovarian cyst in a newborn: a case report]. / Cisti ovarica in eta' neonatale: a proposito di un caso clinico.

The presence of ovarian cysts in the newborn is often a sign of an abnormal exacerbation of the physiologic process. In our case a large cyst caused symptoms related to gastroesophageal reflux: vomiting, poor weight gain, and respiratory disorders. Ultrasound examination enabled a correct diagnosis.

Usefulness of lung ultrasound in a newborn with pulmonary atelectasis.

The use of ultrasound for the evaluation of the lung is relatively recent. We describe the case of a newborn with pulmonary atelectasis and shift of the mediastinum underlining both advantages and limits of lung ultrasound (LUS). The baby, 1 month of age, was admitted to our hospital for tachypnoea, vomiting and poor weight gain. Chest X-ray (CXR) showed displacement of the heart to the right, suggesting the presence of atelectasis of the right lung. LUS confirmed the displacement of the mediastinum to the right and atelectasis of the right lung, clearly visible as a consolidation with the presence of air bronchograms. The computed tomography image showed that the lung parenchyma displayed in the right hemithorax could be attributed to the hyperexpanded left lung. However, once this information was acquired, and compared to the ultrasound picture, we were able to monitor the patient by LUS until normalization, thus avoiding further exposure to ionizing radiation. Our case, in accordance with the recent Literature, indicates that LUS can be adopted as a simple and non-invasive method for evaluating children with lung disease. It is easy to perform at bedside, allows a close follow-up and avoids the use of ionizing radiation.

[Celiac disease associated with chronic autoimmune hepatitis. Description of a case]. / Associazione tra malattia celiaca ed epatite cronica autoimmune. Descrizione di un caso.

The authors describe a case of coeliac disease and autoimmune chronic hepatitis in the same patient. Case description allows a critical review of the literature and evaluation of pathogenetic hypotheses.

[24-hour esophageal pH-metry in the evaluation of gastroesophageal reflux pathology]. / La pH-metria esofagea delle 24 ore nella valutazione della patologia da reflusso gastroesofageo.

Gastro-esophageal reflux (GER) in infants was studied using 24-hour esophageal pH monitoring. Gastro-esophageal reflux was detected in 32/41 subjects. In our patients the main symptoms were vomiting, regurgitation, failure-to-thrive, chronic respiratory problems such as asthma, apnea, recurrent pneumonia. All patients with GER were treated appropriately with prone positioning and medical therapy (prokinetic agent and, eventually, ranitidine). Successful treatment of the reflux was obtained in all patients. In our opinion the 24-hour intraesophageal pH monitoring is a highly diagnostic test to identify the presence of GER and evaluate its gravity.

[Use of intravenous immunoglobulins in Guillain-Barré syndrome]. / L'impiego delle immunoglobuline per via endovenosa nella sindrome di Guillain-Barré.

The aim of the study was to assess the utility of intravenous integral molecule immunoglobulin treatment in Guillain-Barré syndrome. The etiopathogenesis of this syndrome is still unclear but it seems increasingly likely that immune phenomena are involved in the genesis of the neurological lesions. This would explain the efficacy of iv immunoglobulin treatment even if the effective mechanism of action can still only be hypothesised.

[Celiac disease and autoimmunity]. / Malattia celiaca ed autoimmunità.

Immune mechanisms have been invoked to explain coeliac disease and associations between this and other immunologically mediated diseases have been described. A direct relationship proposed is that coeliac disease may be associated with a range of autoimmune disease through the formation of immune complexes in the small intestine. It's more probable a common origin in an inherited predisposition to hypersensitive immuno responses to extrinsic antigens or auto-antigens. The association between coeliac disease and particular histocompatibility antigens was recognised.

[The prevalence of celiac disease in children with short stature in the absence of other symptomatology]. / Prevalenza della malattia celiaca in bambini con bassa statura in assenza di altra sintomatologia.

Using an enzyme-linked immunosorbent assay (ELISA), the authors studied the sera of 116 patients with short stature of undetermined cause and no gastrointestinal symptoms, for the levels of IgG and IgA antigliadin antibodies (AGA). AGA of IgG and IgA isotypes were positive in 8 patients (group 1); only AGA IgG were positive in 7 patients (group 2). Both groups with positive AGA had subsequent duodenal biopsy that showed a villous atrophy in all children in group 1 and in two in group 2. These patients showed a significant acceleration in height velocity after the introduction of a gluten-free diet.

[Anti-beta-lactoglobulin antibodies as an index of increased intestinal permeability in celiac disease]. / Gli anticorpi anti beta-lattoglobulina come indice di aumentata permeabilità intestinale in corso di malattia celiaca.

IgG antibodies to beta-lactoglobulin (ABLG) were assayed in children with coeliac disease (20 at gluten-containing diet and 35 at gluten-free diet) and in 28 "gastrointestinal" controls. Pathologic levels of ABLG were found in 16 patients with active coeliac disease (80%). In these patients the ABLG mean value was significantly higher than that found in the controls (p less than 0.001). In coeliac subjects at gluten-free diet, normal levels of ABLG were found after 6 months of diet. The presence of ABLG in the majority of untreated coeliac patients may reflect an increased permeability of the intestinal mucosa during the active stage of the disease.

[Clinical aspects of celiac disease. Comparison of 2 periods: before and after the introduction of antigliadin antibody determination in clinical practice]. / Gli aspetti clinici della malattia celiaca. Confronto tra due periodi: prima e dopo l'introduzione del dosaggio degli anticorpi antigliadina nella pratica clinica.

The clinical aspects of coeliac disease before and after anti-gliadin antibodies (AGA) assessment in clinical practice, referring to personal experience (107 cases in the period 1976-1988) are described. AGA determination has executed by two different ELISA methods. The diagnosis of coeliac disease in the period 1976-1986 has been made according to ESPGAN criteria, while in the last two years following the recent SIP advice. After 1987 with the introduction of AGA assay, the number of diagnosis/year of coeliac disease has increased three times in respect of the period 1976-1986. We have observed a more marked increase of the late beginning forms (from 2.8 to 10 diagnosis/year) in respect of the early beginning ones (from 3.7 to 7.5 diagnosis/year) and of the atypical forms (from 0.7 to 9 diagnosis/year) in respect of the typical ones (from 5.8 to 8.5 diagnosis/year). According to these data we think that prevalence of coeliac disease in our country is probably underestimated. AGA determination is at time most effective mean to make a screening of coeliac disease in the population. According to us the largest employment of this method in the next years could take a most exact estimate of the coeliac disease prevalence in our country.

[Selenium in celiac disease]. / Il selenio nella malattia celiaca.

Statistically significant lower levels of selenium (p less than 0.001) have been found both in 37 celiac subjects at free diet and in 36 at gluten-free diet with respect to controls. In patients at free diet the deficit of selenium can be attributed to malabsorption, while in patients at gluten-free diet it may be due to the diet itself. Recently low serum levels of selenium have been observed in several neoplasias; furthermore it's known that celiac patients show an increased incidence of gastrointestinal tumors related to known levels in standard population. Long term monitoring is therefore necessary to integrate diet with selenium in patients showing persistent deficit of this element.

[The value of determining anti-gliadin antibodies as well as carotene and xylose blood levels in various phases of celiac disease]. / Utilità della determinazione degli anticorpi anti-gliadina, della carotenemia e della xilosemia nelle varie fasi della malattia celiaca.

The usefulness of measuring xylosaemia, carotenaemia and the antigliadin antibodies in the diagnosis and monitoring of coeliac diseases has been examined, 89 children, 57 with aspecific chronic diarrhoea and 32 with coeliachia were examined. The xylose proved less sensitive (80%) and less specific (84.2%) than carotenaemia (respectively: sensitivity 86.6% and specificity 87.7%). Nevertheless, considering the by no means negligible percentage of false positives and false negatives encountered with both techniques, it should be reiterated that these tests have a purely orientative value, whereas measurement of serum AGA may be considered a highly reliable investigation for selective children to be submitted to biopsy, considering the high sensitivity (AGA IgG 100%; AGA IgA 90.9%) and specificity (AGA IgG 85%; AGA IgA 100%) observed in the present series.

[Fecal chymotrypsin in the evaluation of exocrine pancreatic function]. / La chimotripsina fecale nella valutazione della funzionalità pancreatica esocrina.

In this study the Authors examine the usefulness in determining Fecal Chymotrypsin (FC) as a screening test for pancreatic exocrine insufficiency. The FC was measured in 503 children (337 control subjects and 166 with various intestinal and hepatobiliary diseases). The results demonstrate that FC is usefull as a screening test for pancreatic insufficiency. However, in certain cases, this should be supplemented by the more discriminant analysis of function provided by duodenal studies.